Tuberculosis remains a threat to Houstonians

Despite advances, more must be doneto combat disease

President George W. Bush signed the United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008 with first lady Laura Bush by his side.

Sunday is World Tuberculosis Day. Often believed to be a disease of the past, TB still affects 9 million people and causes 1.4 million fatalities every year.

While 95 percent of these cases occur in low- and middle-income countries, TB does not acknowledge boundaries or wealth, and the United States is still not free of the disease, with over 10,000 cases diagnosed every year. Serious cases of TB are treated daily in the Texas Medical Center.

One morning three weeks ago, medical staff saw 15 children and heard seven languages spoken in the clinic. We also care for several children with multi-drug resistant TB (MDR-TB), the difficult-to-treat form that has spread throughout the world.

In a best case scenario, a TB patient in the United States who adheres to a proper regimen of medications can be cured in six months at a cost of approximately $5,000. If the patient has MDR-TB, or even worse, extensively drug resistant TB (XDR-TB), the treatment lasts at least two years and sometimes even requires surgery, and costs a minimum of $200,000. In 1991, approximately 200 people contracted MDR-TB in New York City and the total bill was more than $1 billion.

Through tremendous effort, strong expertise and improved funding, we have reduced the number of cases of TB in the U.S. However, TB is not under control in developing countries and this poses a huge public health threat for the United States.

As a hub of international travel and commerce, Houston is especially vulnerable to global health issues.

Thankfully, there are signs of hope for greatly reducing the incidence of TB worldwide and the United States has shown excellent leadership in supporting tuberculosis treatment and research.

In Congress, co-chairs of the House Tuberculosis Elimination Caucus, U.S. Reps. Gene Green, D-Houston, Eliot Engel, D-N.Y., and Don Young, R-Alaska, work to raise awareness of TB issues. There has also been major legislation passed, including the Comprehensive TB Elimination Act of 2008, which was sponsored by Rep. Green and former Reps. Heather Wilson, R-N.M., and Tammy Baldwin, D-Wis. (Baldwin now is a U.S. Senator.) This law provided the Centers for Disease Control Prevention with authority to respond to international outbreaks of XDR-TB and increased funds for their TB elimination program. The law also expanded research on TB diagnostic and treatment tools at the National Institute of Health (NIH) and CDC.

Another sign of hope is the possible development of a new vaccine for TB. The Bill and Melinda Gates Foundation is leading this effort, and has invested more than $200 million in search of a new vaccine. More than a dozen candidate vaccines are currently undergoing clinical trials.

Two other signs of hope are a new diagnostic procedure which can accurately identify drug-resistant TB in a matter of hours instead of weeks, and a new tuberculosis drug, Bedaquiline - the first new TB drug approved in the past 45 years - that could provide a breakthrough in treating MDR-TB and XDR-TB. Producing the new drug, diagnostic procedure, and making the vaccine widely available in the developing world will take lots of money initially, but will ultimately save money and millions of lives.

The United States has done an excellent job of funding for global health, and is a major donor to the Global Fund for AIDS, Tuberculosis and Malaria. Our support has stimulated other donor countries to contribute $2 for every $1 the United States donates.

As Congress examines our federal budget, it is important that our nation continues to support the Global Fund as well as TB research.

Starke is a professor of pediatrics at Baylor College of Medicine and director of Children's Tuberculosis Clinic at Texas Children's Hospital. Green, a Democrat, is a U.S. congressman representing Houston.